Acute Treatment Outcomes and Family Functioning of Children and Adolescents Diagnosed with Anorexia Nervosa

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Abstract

Recent studies have suggested that there is a relationship between treatment outcomes and baseline factors related to family functioning and specific eating disorder symptoms. However, these relationships have not been studied extensively within a pediatric population hospitalized for treatment. Therefore, it is unknown whether these relationships exist within an acutely ill population and whether these baseline characteristics improve significantly immediately following acute hospitalization. Given these limitations, the aims of the present study were to identify aspects of family functioning and eating cognitions and attitudes at admission that predict outcome at discharge, and evaluate what aspects of family functioning and eating cognitions and attitudes improve during an acute treatment period. The sample consisted of 41 patients diagnosed with anorexia nervosa or eating disorder not otherwise specified between the ages of 10 and 17 years. At admission, all patients were administered a structured clinical interview to obtain valid psychiatric diagnoses. Additionally, patients completed self-report measures of eating cognitions, eating attitudes, and family functioning; while parents completed a self-report measure of family functioning. Families also participated in a standardized clinician-rated observational measure of family functioning. All measures were re-administered at discharge, and the patient's body mass index (BMI) at admission and discharge were obtained from the medical record. The attrition rate from intake to discharge for this study was 26.8%. Overall, it appeared that parents and patients perceived their families to be healthy at intake, with little improvements noted over the course of treatment. However, standardized observations characterized these families as being affectively avoidant. Additionally, parental perception of adaptive family functioning at intake was predictive of outcome based upon the unit psychiatrist's assessment, and patient perception of healthy familial Expressiveness at intake was predictive of outcome based upon pathological eating attitudes. BMI and eating attitudes based upon eating behavior during treatment improved significantly over the course of treatment. However, patients continued to endorse unhealthy eating cognitions at discharge. These results suggest that weight restoration and pathological eating behavior are the first symptoms to improve during an aggressive treatment period, and psychological symptoms may require a longer period of treatment to remit.